New clinic key to Sierra Leone’s Ebola fight

Kenema, Sierra Leone – The second Ebola treatment centre to be built from scratch in Sierra Leone is set to admit its first wave of patients this weekend.

The white-tented site stands in lush greenery off a main highway a few kilometres outside the Ebola-ravaged eastern city of Kenema, about six hours’ drive from the capital Freetown.

It has been built by the International Federation of the Red Cross (IFRC) in their first attempt so far to run an Ebola treatment facility.

Ebola has killed 436 people in Sierra Leone, with 1,341 confirmed cases overall, according to the Ministry of Health’s latest figures. The true numbers are unknown but likely far higher.

The IFRC hospital will hold 60 patients at full capacity and was built from nothing in three weeks, aiming to take new Ebola cases from the surrounding district.

It will also relieve pressure on the now infamous Kenema government hospital where remaining staff continue to treat patients in the same wards where up to 30 doctors and nurses have been infected and died since the start of the outbreak.

“Usually with a Red Cross field hospital we could open today, but we have had to wait for final building materials to arrive because once you admit the first patient, a construction worker can’t go back in and add parts,” Steve McAndrew, head of emergency operations for IFRC Sierra Leone, told Al Jazeera in the capital Freetown.

Lack of medical staff

The team is ready, according to Tiina Saarikoski, manager of the new Kenema Ebola treatment centre (ETC), the day before the proposed opening. “This hospital wouldn’t be open if I wasn’t 100 percent sure. We will not take risks.”

But they are only prepared for an initial admission of 40 patients and it will not be an easy start.

“We are still waiting for more PPE (Personal protective equipment for staff) due to arrive by truck today. We have 600 on site and I have requested another 2,000 sets,” Saarikoski said.

Staff at a treatment facility like this may use and destroy up to 200 sets of PPE per day.

There is also a crippling shortage of people willing and capable to work in these conditions. “The IFRC hospital hired and trained 35 national nurses for the site but 15 have since decided they do not want the job.

“They are afraid,” said Thomas Abu, caretaker manager for the local Sierra Leone Red Cross Society at his current base in Kenema town.

Three of the nurses recruited from Freetown are staying in the Kenema Red Cross guesthouse. It is their first time there and their first time working on Ebola.

Aisatu Turay, 27, said the reason they were in the guesthouse was because people in the town were still unwilling to host Ebola workers.

“We are here to save lives,” she told Al Jazeera. “We are not afraid, it is our duty and we want to work.”

Despite the fear and stigmatisation, International Red Cross staff who recruited their local colleagues in advance of the opening have been struck by people’s need to rally for their brothers and sisters to beat this disease.

“You have to be brave to choose this sort of mission,” Lauralee Morris, senior medical officer at the site, said.

Morris volunteered for the Ebola project from Canada and has trained the nurses and hygienists who will be working alongside her while learning the ropes first time herself.

“It is important to provide a safe place for patients where they won’t infect their families but can be cared for in a nice environment.”

This treatment facility is modelled on Sierra Leone’s original treatment centre, built by Médecins Sans Frontières in June in the remote epidemic epicentre of Kailahun.

Patients were being driven 12 hours from Freetown to the MSF centre but Kenema’s opening and a third site under construction in nearby Bo are intended to alleviate the strain.

The Kenema centre hopes to have improved the hospital water distribution system such that it flows round this site more efficiently and has also added special “vomit tanks” which the MSF centre does not have.

That these crisis response teams are breaking new boundaries with Ebola cannot be underestimated.

“It’s a massive operation. This has never happened before on this scale, there is no handbook for this,” Steve McAndrew said.

Sierra Leone’s new Ebola hospitals are preparing to treat people at full capacity for six to nine months at least, but nobody knows where this epidemic is going.

Despite a positive, ready-for-action attitude from on-site personnel, resources are still critically lacking and generally insufficient to cope with an ever-increasing number of Ebola infections.

“We need more beds and there are still not enough treatment facilities to cope with the patient-load,” said Saarikoski.

Sierra Leone’s Red Cross Ebola team has so far received 20 percent of the funding it asked for having increased its appeal from $6m in July to $32m now.

Ebola checkpoints

Nevertheless Sierra Leone finally appears to be getting to grips with its Ebola response.

Checkpoints along the main highways have increased tenfold and military officials have become stricter, demanding newly introduced Special Ebola Response passes issued for cross-country travellers by the Health Ministry.

Every checkpoint is manned by volunteer health workers using temperature guns to test for those travelling with a fever.

Most checkpoint health operators told Al Jazeera they had only recorded one or two individuals with worrisome fevers in the last two weeks.

However, it is hard to keep track with equipment breaking, being lost, and general uncertainty about its efficiency in detecting potential Ebola cases.

“Usually when somebody comes with a fever of 37 degrees they panic,” one young volunteer said.

“We calm them, talk to them, wait for a while then test again. If the temperature is the same we call the medical officer for help.”

There are also complaints from local coordinators about “medical staff at Ebola checkpoints not devoted to their jobs” and power struggles between officials from different localities deployed to monitor travellers.

However, government restrictions do not seem to be hindering the movement of what people and supplies there are in transit for Sierra Leone’s Ebola crisis response.

“We have free passes to move and the local and national authorities have been very supportive and accommodating. They are actively encouraging us,” Tiina Saarikoski said.

Providing she receives her shipment of PPE from Freetown, Saarikoski plans to open the centre on Friday afternoon with an admission of four patients.

“I hope that when we open it is controlled,” she said, “we are not ready to take 60 patients immediately. That would create chaos.”

The site only has enough staff and equipment to cope with up to 40 at present, with an increased capacity dependent on continued delivery of supplies and the recruitment and training of more local and international workers.